• Mehran Sotoodehnia, Arash Safaei, Fatemeh Rasooli, and Maryam Bahreini.
• Tehran University of Medical Sciences, Department of Emergency Medicine, Sina Hospital, Hasan Abad Square, Imam Khomeini Ave, Tehran, Iran.
• Am J Emerg Med. 2017 Jun 1; 35 (6): 934.e1-934.e2.

BackgroundThe diagnosis of cerebral venous sinus thrombosis still remains a real challenge. Seizure, unusual headache with sudden onset, unexplained persistently unilateral vascular headache and neurologic deficit-which is difficult to be attributed to a vascular territory are some of the suggestive symptoms.CaseAn isolated sixth nerve palsy is discussed as a rare presentation for cerebral venous thrombosis. Following the extensive investigation to rule out other possible diagnoses, magnetic resonance venogram revealed the final etiology of sixth nerve palsy that was ipsilateral left transverse sinus thrombosis; therefore, anticoagulant treatment with low molecular weight heparin was administered.ConclusionRapid and accurate diagnosis and treatment cause to achieve excellent outcomes for most patients. Considering different clinical features, risk factors and high index of suspicion are helpful to reach the diagnosis.Copyright © 2016 Elsevier Inc. All rights reserved.

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